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Aim: We wanted to investigate whether an electric rocking device (Swing2Sleep, Neumünster, Germany), sold with the claim to promote infant sleep, would increase total sleep time or reduce sleep latency once infants are put therein., Methods: In a randomised crossover design, 20 infants (median gestational age at birth 31.7 weeks, range 25-39) were placed to sleep either first with the device rocking, then not rocking (or vice versa) for 5-7 h each. The device consisted of a hammock with three spiral springs that performed vertical swings at a rate of 100/min and an amplitude of 2.5 cm., Results: There was no significant difference in %time spent asleep (83 (22-97) vs. 85% (49-96)), sleep latency (7.7 (2-45) vs. 12.3 (4-42) min), sleep fragmentation (1.3 (0.5-2.3) vs. 1.1 (0.2-5.5)) or efficiency (0.8 (0.2-1.0) vs. 0.9 (0.5-1.0)) between both conditions., Conclusion: At its recommended settings, the device did not achieve its intended effect in these infants., (© 2024 The Authors. Acta Paediatrica published by John Wiley & Sons Ltd on behalf of Foundation Acta Paediatrica.) more...

Study Objectives: To investigate neurocognitive and behavioral outcomes at primary school age in relation to obstructive sleep apnea (OSA) in children with Robin sequence (RS) treated with the Tuebingen palatal plate in infancy and to assess the impact of OSA in these patients., Methods: Forty-two primary school-aged children (n = 21 with RS, n = 21 age- and sex-matched controls) underwent polysomnography, intelligence testing ("Wechsler Intelligence Scale for Children-Fifth Edition" [WISC-V]), and anthropometrics. Families completed a 7-day sleep diary and questionnaires on sleep and behavior (Children's Sleep Habits Questionnaire [CSHQ] and the Child Behavior Checklist [CBCL])., Results: In children with RS (17 non-syndromic, four syndromic; median age 9.7 [8.5-10.8] years), the obstructive apnea-hypopnea index (OAHI) was significantly higher than in controls (1.3 [0.4-2.7]/h vs. 0.4 [0.1-0.6]/h). Two syndromic children with RS were already on nocturnal respiratory support for OSA prior to our study, and one non-syndromic child was diagnosed with severe OSA (OAHI 57/h) despite an unremarkable medical history and questionnaire. The overall intelligence quotient in children with RS was within the normal range and did not differ between children with RS and healthy peers (102 vs. 108, p = .05). However, children with RS had values in the at-risk clinical range for externalizing behavior., Conclusions: These children with RS showed an increased risk of OSA and behavioral problems, suggesting regular screening for OSA throughout childhood. Neurocognitive scores in children with RS were within the normal range after adequate treatment of OSA during infancy., (© The Author(s) 2022. Published by Oxford University Press on behalf of Sleep Research Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.) more...

Objective: To characterize family and environmental correlates of sleep patterns that may contribute to differences in infant sleep., Methods: We studied 313 infants in the Rise & SHINE (Sleep Health in Infancy & Early Childhood study) cohort. Our main exposures were the parent-reported sleep environment, feeding method and sleep parenting strategies at infant age one month. The main outcomes were nighttime sleep duration, longest nighttime sleep and number of awakenings measured by actigraphy at age six months. We used multivariable linear regression models to examine associations, and secondarily also explored the role of sleep-related environmental exposures in mediating previously observed associations of racial/ethnicity and parental education with infant sleep characteristics., Results: In adjusted models, a non-dark sleep environment (versus an always dark sleep location) and taking the baby to parent's bed when awake at night (versus no co-sleeping) were associated with 28 (95% CI, -45, -11) and 18 (95% CI, -33, -4) minutes less sleep at night, respectively. Bottle feeding at bedtime was associated with 62 (95% CI, 21, 103) minutes additional longest nighttime sleep period. Exploratory mediation analyses suggested a modest mediating role of a non-dark sleep environment on racial/ethnic and educational differences in sleep duration., Conclusions: Infant sleep duration was positively associated with a dark sleep environment and a focal feed at bedtime while taking the baby to the parent's bed was associated with reduced infant sleep. Modifying the sleep environment and practices may improve infant sleep and reduce sleep health disparities., (Copyright © 2022 Elsevier B.V. All rights reserved.) more...

Background: Sleep is an important aspect of child development and health. Disparities in childhood sleep have been observed as early as infancy, but little is known about the factors contributing to them., Purpose: The objective of this study was to examine whether intrinsic, contextual, and parenting factors contribute to differences in sleep duration between Hispanic/Latinx and non-Hispanic white infants at 6 months of age., Methods: We analyzed data of 119 Hispanic/Latinx and 146 non-Hispanic white infants in Rise & SHINE, a prospective birth cohort study of mother-infant dyads. Mothers reported their infant's sleep patterns using the Brief Infant Sleep Questionnaire at 6 months. Mothers also completed surveys measuring intrinsic (sex, gestational length, and birth weight), contextual (cultural, environmental, and familial), and parenting (behaviors and practices) factors. We used multivariable linear and logistic regression analyses to examine the contributing effects of these clusters of variables on the association between racial/ethnic background and infant sleep duration., Results: Hispanic/Latinx infants slept 38 min less than white infants at 6 months (β: -0.63 [95% confidence interval: -1.07, -0.19]) and were nearly three times more likely to not meet the minimum sleep recommendation. The differences persisted after adjustment for intrinsic factors but were attenuated after additional adjustment for contextual and parenting factors, especially having a foreign-born mother and later bedtime., Conclusions: The results of this study demonstrate that differences in sleep duration among Hispanic/Latinx infants compared to their white counterparts are present as early as 6 months of age and that context and parenting matter., (© Society of Behavioral Medicine 2020. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.) more...

Study Objectives: To compare the estimates of sleep duration and timing from survey, diary, and actigraphy in infants at age 6 months, overall and by select demographics and other factors., Methods: In total, 314 infants participating in the Rise & SHINE (Sleep Health in Infancy & Early Childhood study) cohort in Boston, MA, USA, wore an actigraph on their left ankle for 7 days. Parents concurrently completed a sleep diary and the expanded version of the Brief Infant Sleep Questionnaire. Concordance between parent-reported and objective sleep estimates was assessed using Bland-Altman plots, Spearman's rank correlations, intraclass correlations, and linear regression models., Results: Mean infant age was 6.4 (0.6 SD) months; 51% were female and 42% were Non-Hispanic white. Mean total sleep duration using actigraphy was 526 (67 SD) minutes per night, 143 (42 SD) minutes per day, and 460 (100 SD) minutes during the longest nighttime sleep period. Relative to actigraphy, parent-completed survey and diary overestimated total day (by 29 and 31 minutes, respectively) and night sleep duration (67 and 43 minutes, respectively) and underestimated the longest sleep (58 minutes), with the highest agreement for sleep onset and offset timing (differences < 30 minutes). There was a tendency toward greater bias among short- and long-sleeping infants. Self-reporting bias for diary-measured longest nighttime sleep and total night sleep duration was higher in infants of parents reporting a problem with their baby's night awakenings and in low-income families, respectively., Conclusions: Our findings underscore the need to be cautious when comparing findings across studies using different sleep assessment methods., (© Sleep Research Society 2020. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail journals.permissions@oup.com.) more...

Study Objectives: To characterize objectively assessed sleep-wake patterns in infants at approximately 1 month and 6 months and examine the differences among infants with different racial/ethnic backgrounds and household socioeconomic status (SES)., Methods: Full-term healthy singletons wore an ankle-placed actigraph at approximately 1 month and 6 months and parents completed sleep diaries. Associations of racial/ethnic and socioeconomic indices with sleep outcomes were examined using multivariable analyses. Covariates included sex, birth weight for gestational age z-score, age at assessment, maternal education, household income, bed-sharing, and breastfeeding., Results: The sample included 306 infants, of whom 51% were female, 42.5% non-Hispanic white, 32.7% Hispanic, 17.3% Asian, and 7.5% black. Between 1 month and 6 months, night sleep duration increased by 65.7 minutes (95% CI: 55.4, 76.0), night awakenings decreased by 2.2 episodes (2.0, 2.4), and daytime sleep duration decreased by 73.3 minutes (66.4, 80.2). Compared to change in night sleep duration over this development period for white infants (82.3 minutes [66.5, 98.0]), night sleep increased less for Hispanic (48.9 minutes [30.8, 66.9]) and black infants (31.6 minutes [-5.9, 69.1]). Night sleep duration also increased less for infants with lower maternal education and household income. Asian infants had more frequent night awakenings. Adjustment for maternal education and household income attenuated all observed day and night sleep duration differences other than in Asians, where persistently reduced nighttime sleep at 6 months was observed., Conclusions: Racial/ethnic differences in sleep emerge in early infancy. Night and 24-hour sleep durations increase less in Hispanic and black infants compared to white infants, with differences largely explained by SES., (© Sleep Research Society 2020. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail journals.permissions@oup.com.) more...

Background Accumulating evidence suggests a relationship between sleep alterations and overweight/obesity in children. Our aim was to investigate the association of sleep measures other than obstructive sleep apnea or sleep duration with overweight/obesity and metabolic function in children. Methods We conducted a prospective cohort study in school- aged children (aged 5 to 8 years, prepubertal, and 12 to 15 years, pubertal) with overweight/obesity and normal-weight children. All children underwent a standardized in-laboratory polysomnography followed by a fasting blood assessment for glucose and metabolic testing. Subjective sleep measures were investigated by a 7-day sleep diary and questionnaire. We analyzed prepubertal and pubertal groups separately using logistic regression and partial correlation analyses. Results A total of 151 participants were analyzed. Overweight/obese children had significantly higher odds for arousal index (prepubertal children: 1.28, Confidence interval (CI): 1.06, 1.67; pubertal children: 1.65, CI: 1.19, 2.29) than normal-weight children, independent of age and gender. In prepubertal children, arousal-index was positively associated with C-peptide (r=0.30, p=0.01), whereas Minimum O2 saturation was negatively associated with triglycerides (r=-0.34, p=0.005), adjusting for age and sex. However, associations were attenuated by further adjustment for body mass index standard deviation scores (BMI-SDS). In pubertal children, higher level of apnea-hypopnea-index and pCO2 predicted increased lipoprotein (a) levels (r=0.35, p=0.03 and r=0.40, p=0.01, respectively), independent of age, sex, and BMI-SDS. A negative association was found between pCO2 and high-density lipoprotein (HDL)-cholesterol (r=-0.40, p=0.01). Conclusions Overall, we report that sleep quality as measured by arousal index may be compromised by overweight and obesity in children and warrants attention in future intervention programs. more...

Background : Daily behaviors such as sleep can be targeted by smartphone app-based interventions, with potential utility among young people of minority ethnic backgrounds who commonly access smartphone devices and are short sleepers. There is a need to understand the acceptability and youth's readiness to use apps to improve sleep, and to identify desired app components that would motivate engagement. Participants and Methods : We conducted three focus group discussions ( N  = 27 total, age 14-18 years) within low- and middle-income ethnically diverse Boston neighborhoods. We also interviewed 10 participants who provided specific feedback on two commercially available sleep-promoting apps, one of which they had used on their smartphone preceding the interviews. All focus group discussions and interviews were audio-recorded, transcribed, and thematically analyzed. Results : We identified several barriers to adoption of sleep hygiene interventions, namely reluctance to follow scheduled sleep routines on weekends and concern about "parting" with electronics at bedtime. Participants were intrigued by the idea of adopting an app-based sleep intervention, but were skeptical that they could successfully adopt sleep hygiene practices, and were more interested in making changes on school days than on weekends. Nonetheless, the overall feedback on two commercial sleep apps, neither targeted at youth, was positive, with a good adherence and engagement rate, and perceived health benefits. Conclusions : Our findings highlight the need to adapt sleep hygiene recommendations to targeted populations, considering preferences and social and cultural contextual factors. Our research also underscores the importance of the platform, setting, and messenger when delivering health information to adolescents. more...

Purpose: Emerging data indicate that the timing and rhythms of energetic behaviors may influence metabolism and obesity risk. Our aim was to derive diurnal rest-activity patterns from actigraphy in adolescents and analyze associations with adiposity measures and cardiometabolic risk factors., Methods: Adolescents in the Project Viva cohort wore a wrist actigraph over 7 days. We derived markers of daily rest-activity patterns from actigraphy using nonparametric models, generating measurements of relative amplitude (RA). RA reflects the normalized difference in activity measured during the most active 10-hour period and the least active 5-hour period, averaged over multiple 24-hour periods. Using multivariable-adjusted linear regression models, we estimated associations of RA and its components with markers of adiposity (body mass index, waist circumference, skinfolds, dual-energy X-ray absorptiometry fat mass) and cardiometabolic health (cardiometabolic risk score, derived as the mean of five sex-specific internal z-scores for waist circumference, systolic blood pressure, high-density lipoprotein cholesterol scaled inversely, and log-transformed triglycerides and homeostatic model assessment of insulin resistance)., Results: A total of 778 adolescents provided at least 5 days of valid actigraphy data. The average age was 13.2 (±.9) years, 52% were female, and the average RA was .9 (±.1). A higher RA reflecting higher activity during wakefulness and lower activity during the night was associated with more favorable indices of adiposity (e.g., -.35 kg/m 2 lower body mass index per each .04 units increment of RA; 95% confidence interval: -.60 to -.09)., Conclusions: In this large sample of adolescents, a higher RA emerged as a novel biomarker, associated with more favorable cardiometabolic profiles., (Copyright © 2019 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.) more...

Background : Understanding variation in physical activity (PA) and sleep is necessary to develop novel intervention strategies targeting adolescents' health behaviors. We examined the extent to which PA and sleep vary by aspects of the physical environment. Participants : We performed a cross-sectional analysis of 669 adolescents in the Project Viva cohort. Methods : We estimated total PA, sleep duration, sleep efficiency, and sleep midpoint timing from wrist accelerometers. We used multivariable linear regression models and generalized estimated equations to assess associations of PA and sleep with season and daily weather conditions obtained from the National Oceanic and Atmospheric Administration archive. Results : Mean age was 12.9 ( SD 0.6) years; 51% were female and 68% were white. Mean sleep duration was 466 ( SD 42) min per night and total PA was 1,652 ( SD 431) counts per min per day. Sleep midpoint time was 41 (95% CI: 27 to 54) min later in summer, 28 (95% CI: -41 to -14) min earlier in spring, and 29 (95% CI: -43 to -15) min earlier in autumn compared to winter. Higher temperature and longer day length both were associated with small reductions of nightly sleep duration. Adolescents were less physically active during winter and on rainy and short sunlight days. There was an inverse U-shaped relationship between PA and mean temperature. Conclusions : Season was associated with large changes in sleep timing, and smaller changes in other sleep and PA measurements. Given the importance of sleep and circadian alignment, future health behavioral interventions may benefit by targeting "season-specific" interventions. more...

Background: This study tested if the timing of meals, physical activity, light exposure, and sleep cluster within individuals and are associated with body mass index (BMI) in a sample of free-living adults (N = 125)., Methods: Data were collected between November 2015 and March 2016 at the University of California, San Diego, Children's Hospital of Philadelphia, and Washington University in St Louis. Height and weight were measured, and BMI (kg/m 2 ) was calculated. Sleep timing was estimated using actigraphy, and timing of meals, physical activity, and light exposure were self-reported using a smartphone application. General linear models estimated the mean BMI across time categories of behaviors, adjusting for covariates. A latent class analysis was used to identify patterns of timing variables that clustered within individuals and test for associations between identified patterns and BMI., Results: Later exposure to outdoor light was associated with a lower BMI (P trend < .01). The timing of other behaviors was not independently associated with BMI. The latent class analysis identified 2 distinct groups related to behavioral timing, reflecting an "early bird" and "night owl" phenotype. These phenotypes were not associated with BMI (P > .05)., Conclusion: Timing of exposures to light, meals, sleep, and physical activity were not strongly associated with BMI in this sample. more...

: media-1vid110.1542/5778442247001PEDS-VA&#95;2017-4085 Video Abstract BACKGROUND AND OBJECTIVES: Shorter sleep duration is associated with childhood obesity. Few studies measure sleep quantity and quality objectively or examine cardiometabolic biomarkers other than obesity., Methods: This cross-sectional study of 829 adolescents derived sleep duration, efficiency and moderate-to-vigorous physical activity from >5 days of wrist actigraphy recording for >10 hours/day. The main outcome was a metabolic risk score (mean of 5 sex-specific z-scores for waist circumference, systolic blood pressure, high-density lipoprotein cholesterol scaled inversely, and log-transformed triglycerides and homeostatic model assessment of insulin resistance), for which higher scores indicate greater metabolic risk. Secondary outcomes included score components and dual-energy radiograph absorptiometry fat mass. We measured socioeconomic status, race and/or ethnicity, pubertal status, and obesity-related behaviors (television-viewing and fast food and sugar-sweetened beverage consumption) using questionnaires., Results: The sample was 51.5% girls; mean (SD) age 13.2 (0.9) years, median (interquartile range) sleep duration was 441.1 (54.8) minutes per day and sleep efficiency was 84.0% (6.3). Longer sleep duration was associated with lower metabolic risk scores (-0.11 points; 95% CI: -0.19 to -0.02, per interquartile range). Associations with sleep efficiency were similar and persisted after adjustment for BMI z score and physical activity, television-viewing, and diet quality. Longer sleep duration and greater sleep efficiency were also favorably associated with waist circumference, systolic blood pressure, high-density lipoprotein cholesterol, and fat mass., Conclusions: Longer sleep duration and higher sleep efficiency were associated with a more favorable cardiometabolic profile in early adolescence, independent of other obesity-related behaviors. These results support the need to assess the role of sleep quantity and quality interventions as strategies for improving cardiovascular risk profiles of adolescents., Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2018 by the American Academy of Pediatrics.) more...

Study Objectives: To examine associations between 24-hour rest-activity patterns and body mass index (BMI) among community-dwelling US adults. Rest-activity patterns provide a field method to study exposures related to circadian rhythms., Methods: Adults (N = 578) wore an actigraph on their nondominant wrist for 7 days. Intradaily variability and interdaily stability (IS), M10 (most active 10-hours), L5 (least active 5-hours), and relative amplitude (RA) were derived using nonparametric rhythm analysis. Mesor, acrophase, and amplitude were calculated from log-transformed count data using the parametric cosinor approach., Results: Participants were 80% female and mean (standard deviation) age was 52 (15) years. Participants with higher BMI had lower values for magnitude, RA, IS, total sleep time (TST), and sleep efficiency. In multivariable analyses, less robust 24-hour rest-activity patterns as represented by lower RA were consistently associated with higher BMI: comparing the bottom quintile (least robust) to the top quintile (most robust 24-hour rest-activity pattern) of RA, BMI was 3-kg/m2 higher (p = .02). Associations were similar in magnitude to an hour less of TST (1-kg/m2 higher BMI) or a 10% decrease in sleep efficiency (2-kg/m2 higher BMI), and independent of age, sex, race, education, and the duration of rest and/or activity., Conclusions: Lower RA, reflecting both higher night activity and lower daytime activity, was associated with higher BMI. Independent of the duration of rest or activity during the day or night, 24-hour rest, and activity patterns from actigraphy provide aggregated measures of activity that associate with BMI in community-dwelling adults., (© Sleep Research Society 2017. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail journals.permissions@oup.com.) more...

Physical activity and time spent outdoors may be important non-pharmacological approaches to improve sleep quality and duration (or sleep patterns) but there is little empirical research evaluating the two simultaneously. The current study assesses the role of physical activity and time outdoors in predicting sleep health by using objective measurement of the three variables. A convenience sample of 360 adult women (mean age = 55.38 ±9.89 years; mean body mass index = 27.74 ±6.12) was recruited from different regions of the U.S. Participants wore a Global Positioning System device and ActiGraph GT3X+ accelerometers on the hip for 7 days and on the wrist for 7 days and 7 nights to assess total time and time of day spent outdoors, total minutes in moderate-to-vigorous physical activity per day, and 4 measures of sleep health, respectively. A generalized mixed-effects model was used to assess temporal associations between moderate-to-vigorous physical activity, outdoor time, and sleep at the daily level (days = 1931) within individuals. There was a significant interaction (p = 0.04) between moderate-to-vigorous physical activity and time spent outdoors in predicting total sleep time but not for predicting sleep efficiency. Increasing time outdoors in the afternoon (versus morning) predicted lower sleep efficiency, but had no effect on total sleep time. Time spent outdoors and the time of day spent outdoors may be important moderators in assessing the relation between physical activity and sleep. More research is needed in larger populations using experimental designs. more...

Background: Adipokines have been implicated in obesity, insulin resistance and sleep regulation. However, the role of chemerin and progranulin, two recently described adipokines, in the context of sleep remains unclear. The aim of this study was to compare nocturnal serum chemerin and progranulin levels between overweight/obese and normal-weight adolescents and to assess variations by sex, across different sleep stages and in relation to glucose metabolism., Methods: The study sample included 34 overweight/obese and 32 normal-weight adolescents from secondary schools and the Leipzig Research Center for Civilization Diseases (LIFE) Child study cohort. We obtained longitudinal serum adipokine levels during in-laboratory polysomnography followed by an oral glucose tolerance test., Results: Overweight/obese adolescents had significantly higher mean nocturnal serum chemerin area under the curve (AUC) levels (348.2±133.3 vs. 241.7±67.7 vs. ng/mL×h, p<0.001) compared to normal-weight controls. In detail, higher chemerin AUC levels in obese/overweight subjects were exclusively due to increased levels in females. No overall difference for serum progranulin AUC was found between the groups. However, when assessing sex-specific levels, serum progranulin AUC levels were ~30% higher in overweight/obese males compared to overweight/obese females. Of note, nocturnal serum chemerin and progranulin AUC did not exhibit a correlation with markers of glucose metabolism or sleep stages., Conclusions: Collectively, we report a sexual dimorphism in nocturnal progranulin and chemerin levels, which may help explain underlying differences in energy balance and body composition between males and females in the context of obesity. more...

Rest-activity patterns provide an indication of circadian rhythmicity in the free-living setting. We aimed to describe the distributions of rest-activity patterns in a sample of adults and children across demographic variables. A sample of adults (N = 590) and children (N = 58) wore an actigraph on their nondominant wrist for 7 days and nights. We generated rest-activity patterns from cosinor analysis (MESOR, acrophase and magnitude) and nonparametric circadian rhythm analysis (IS: interdaily stability; IV: intradaily variability; L5: least active 5-hour period; M10: most active 10-hour period; and RA: relative amplitude). Demographic variables included age, sex, race, education, marital status, and income. Linear mixed-effects models were used to test for demographic differences in rest-activity patterns. Adolescents, compared to younger children, had (1) later M10 midpoints (β = 1.12 hours [95% CI: 0.43, 1.18] and lower M10 activity levels; (2) later L5 midpoints (β = 1.6 hours [95% CI: 0.9, 2.3]) and lower L5 activity levels; (3) less regular rest-activity patterns (lower IS and higher IV); and 4) lower magnitudes (β = -0.95 [95% CI: -1.28, -0.63]) and relative amplitudes (β = -0.1 [95% CI: -0.14, -0.06]). Mid-to-older adults, compared to younger adults (aged 18-29 years), had (1) earlier M10 midpoints (β = -1.0 hours [95% CI: -1.6, -0.4]; (2) earlier L5 midpoints (β = -0.7 hours [95% CI: -1.2, -0.2]); and (3) more regular rest-activity patterns (higher IS and lower IV). The magnitudes and relative amplitudes were similar across the adult age categories. Sex, race and education level rest-activity differences were also observed. Rest-activity patterns vary across the lifespan, and differ by race, sex and education. Understanding population variation in these patterns provides a foundation for further elucidating the health implications of rest-activity patterns across the lifespan. more...

Summary: There are only a few validated chronotype and morningness–eveningness questionnaires for adolescents. We evaluated three such questionnaires, namely Morningness–Eveningness Stability Scale improved; reduced Morningness–Eveningness Questionnaire for Children and Adolescents; and Composite Scale of Morningness in adolescents against actigraphy. Fifty‐five healthy 13‐ to 16‐year‐old adolescents completed the Morningness–Eveningness Stability Scale improved, reduced Morningness–Eveningness Questionnaire for Children and Adolescents, Composite Scale of Morningness, and Pediatric Daytime Sleepiness Scale, and provided a 7‐day actigraphy and sleep diary recording about their sleep–wake patterns. We examined the correlations between sleep–wake and activity parameters, and the questionnaires. The influence of age and sex on chronotype classification was studied using uni‐ and multivariate analyses. All three chronotype questionnaires showed good internal consistency and convergent validity. Spearman correlations reflected less daytime sleepiness, earlier sleep times, midpoints of sleep, and acrophase in morning‐oriented participants. Evening‐oriented participants had more sleepiness and later respective sleep–wake times. Chronotype classification differed significantly between questionnaires. The Composite Scale of Morningness classified more participants as morning types when compared with the reduced Morningness–Eveningness Questionnaire for Children and Adolescents (12 versus 7, respectively), and fewer adolescents as evening types (5 versus 9, respectively). Age and sex had no significant influence on questionnaire scores. The Morningness–Eveningness Stability Scale improved, reduced Morningness–Eveningness Questionnaire for Children and Adolescents, and Composite Scale of Morningness are valid instruments to determine circadian preference in adolescents; however, chronotype classification from the Composite Scale of Morningness and reduced Morningness–Eveningness Questionnaire for Children and Adolescents cannot be used interchangeably. [ABSTRACT FROM AUTHOR] more...

Objective: We have used an obstructive apnea index of ≥3 as treatment indication for infants with Robin sequence (RS), while the obstructive apnea-hypopnea index (OAHI) and a threshold of ≥5 is often used internationally. We wanted to know whether these two result in similar indications, and what the interobserver variability is with either asessement.Methods: Twenty lab-based overnight sleep recordings from infants with isolated RS (median age: 7 days, range 2-38) were scored based on the 2020 American Academy of Sleep Medicine guidelines, including or excluding obstructive hypopneas.Results: Median obstructive apnea index (OAI) was 18 (interquartile range: 7.6-38) including only apneas, and 35 (18-54) if obstructive hypopneas were also considered as respiratory events (OAHI). Obstructive sleep apnea (OSA) severity was re-classified from moderate to severe for two infants when obstructive hypopneas were also considered, but this did not lead to a change in clinical treatment decisions for either infant. Median interobserver agreement was 0.86 (95% CI 0.70-0.94) for the OAI, and 0.60 (0.05-0.84) for the OAHI.Conclusion: Inclusion of obstructive hypopneas when assessing OSA severity in RS infants doubled the obstructive event rate, but impaired interobserver agreement and would not have changed clinical management. [ABSTRACT FROM AUTHOR] more...

Objective: Deficient sleep is highly prevalent in disadvantaged adolescents and contributes to a range of adverse health and behavioral outcomes. We examined mediating mechanisms and strategies that adolescents adopt to improve sleep, and possible levers for promoting sleep in this population.Methods: We conducted three focus groups (N = 27 total, age 14-18 years) in adolescents living in low- and middle-income racially/ethnically diverse neighborhoods of Boston, Massachusetts. Participants completed a survey on their sleep and health habits prior to the moderator-led discussions. Discussions were audio-recorded, transcribed, and thematically analyzed.Results: The study population did not meet the minimum sleep recommendations, and we found a high prevalence of "social jet-lag." We also identified a disconnect between the acknowledgment of the importance of sleep and actual behavior, especially for electronic use. Phone use and screen time were the most commonly cited barriers to a good night's sleep, along with caffeine consumption, which was also high in this sample. There was also a general lack of awareness of sleep hygiene practices and recommendations. Participants reported regulating food intake and physical activity, using allopathic sleep aids, creating a comfortable sleeping environment, and a routine as some strategies to improve sleep.Conclusion: Results from this study suggest facilitating the linkage between participant-generated mediating factors and strategies for better-designed interventions. These include making the negative impact of sleep on health more explicit, improving youth awareness about sleep hygiene, targeting caffeine consumption and electronic use, and introducing sleep recommendations through appropriate and effective channels. [ABSTRACT FROM AUTHOR] more...

Zeitgebers such as light, eating and physical activity provide input to the circadian clock. Chronic circadian misalignment is associated with significant adverse health effects. An improved understanding of the impact of the timing of zeitgebers on the stability of 24-hour rest-activity rhythm in free-living settings may identify behavioural and environmental intervention targets. A total of 133 healthy adults, aged 21-60 years, wore a wrist actigraph for 7 consecutive days. We applied a non-parametric analysis to activity counts to derive rest-activity patterns. We administered a questionnaire through a smartphone app to collect self-reported timing of light exposure, eating episodes and physical activity. To assess the relationship between timing exposures (first and last exposure to outdoor light, first exposure to indoor light, last eating episode, first eating episode, morning physical activity proportion, evening physical activity proportion) and rest-activity or sleep outcomes (bedtimes, total sleep time, inter-daily stability, intra-daily variability, L5 and M10 midpoint), we first calculated Spearman correlations, using the false discovery rate method to control for multiple comparisons. From those significant associations, we then fit regression models adjusting for age, sex, race, household income, education level, study site, body mass index, as well as physical activity. Finally, we tested for interaction between chronotype and each timing-related exposure and stratified the analysis by morning type. All zeitgebers, except for evening physical activity proportion, were correlated with at least four of the seven sleep and rest-activity outcomes. In adjusted analysis, later timing of first (after 6:30 to 7:45 AM versus earlier) and last exposure to indoor light (after 11:00 PM versus earlier) and first (after 7:45-9:45 AM versus earlier) and last eating episode (after 8:00-09:00 PM versus earlier) were associated with a shift of 0.60-1.39 hours to later bedtimes, M10 and L5 midpoints (i.e. timing of peak activities or inactivities). Later timing of first exposure to outdoor light (after 09:30 AM versus earlier) was also associated with 0.51 (95% CI: 0.19 to 0.83) hours longer total sleep time. Higher morning physical activity proportion (> 33%) was associated with 0.95 (95% CI: −1.38 to −0.53) hours earlier in-bed time and 0.69 (95% CI: −1.14 to −0.24) hours earlier out-of-bed time, 0.92 (95% CI: −1.41 to −0.42) hours earlier M10 and 0.96 (95% CI: −1.42 to −0.49) min earlier L5 midpoint. The results did not change substantially with further adjustment for total activity. There was a significant interaction between morning chronotype and first eating episode with rest-activity patterns (p < 0.05), with first eating episode associating with timing of activities only in non-morning type adults. Timing of zeitgebers was associated with sleep and rest-activity patterns, including bedtimes, L5 and M10 midpoint. Future research should evaluate the impact of manipulating zeitgebers on both circadian rhythms and health outcomes. [ABSTRACT FROM AUTHOR] more...